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晚期肾细胞癌患者的疗效比较分析:免疫肿瘤学时代与酪氨酸激酶抑制剂时代在国际转移性肾细胞癌数据库协作组(IMDC)低危组中的情况

Comparative Analysis of Outcomes for Patients With Advanced Renal Cell Carcinoma: Immuno-Oncology Era Tyrosine Kinase Inhibitor Era in the IMDC Favorable-risk Group.

作者信息

Ishihara Hiroki, Nemoto Yuki, Mizoguchi Shinsuke, Nishimura Koichi, Fukuda Hironori, Yoshida Kazuhiko, Shimmura Hiroaki, Hashimoto Yasunobu, Iizuka Junpei, Kondo Tsunenori, Takagi Toshio

机构信息

Department of Urology, Saiseikai Kawaguchi General Hospital, Saitama, Japan;

Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.

出版信息

Anticancer Res. 2025 Apr;45(4):1643-1652. doi: 10.21873/anticanres.17545.

Abstract

BACKGROUND/AIM: Scarce data are available on the changes in outcomes related to advanced renal cell carcinoma (RCC), from the previous tyrosine kinase inhibitor (TKI) era to the current immuno-oncology (IO) era, among patients in the IMDC favorable-risk group.

PATIENTS AND METHODS

Among 618 patients with previously untreated advanced RCC according to our database, 72 classified with an International Metastatic RCC Database Consortium (IMDC) favorable risk were selected. These patients were divided into two groups (IO and TKI eras) based on the treatments recognized as the standard of care at the time of their treatment. We compared the effectiveness and safety profiles according to the treatment era.

RESULTS

Out of 72 patients, 31 (43%) were treated in the IO era and 41 (57%) in the TKI era. No significant differences were found in patient backgrounds (>0.05). Progression-free survival (median: 23.0 . 29.3 months, =0.547) and overall survival (median: not reached . 114.7 months, =0.785) showed no significant difference between the two eras. The objective response rate was higher in the IO era (84% . 41%, =0.0003), and the treatment era was an independent predictor of an objective response (odds ratio=0.14, =0.0006). The rates of treatment interruption (65% . 46%, =0.155) and discontinuation (32% . 22%, =0.420) did not significantly differ between eras.

CONCLUSION

The implementation of IO therapies has enhanced tumor response rates among patients within the IMDC favorable-risk group, although extended follow-up is necessary to ascertain any survival benefits.

摘要

背景/目的:关于国际转移性肾细胞癌数据库联盟(IMDC)有利风险组患者从既往酪氨酸激酶抑制剂(TKI)时代到当前免疫肿瘤学(IO)时代与晚期肾细胞癌(RCC)相关的结局变化,可用数据稀缺。

患者与方法

根据我们的数据库,在618例既往未治疗的晚期RCC患者中,选择了72例被分类为IMDC有利风险的患者。这些患者根据其治疗时被认可为标准治疗的方法分为两组(IO时代和TKI时代)。我们比较了不同治疗时代的有效性和安全性。

结果

72例患者中,31例(43%)在IO时代接受治疗,41例(57%)在TKI时代接受治疗。患者背景方面未发现显著差异(>0.05)。无进展生存期(中位数:23.0对29.3个月,P=0.547)和总生存期(中位数:未达到对114.7个月,P=0.785)在两个时代之间未显示出显著差异。IO时代的客观缓解率更高(84%对41%,P=0.0003),且治疗时代是客观缓解的独立预测因素(比值比=0.14,P=0.0006)。治疗中断率(65%对46%,P=0.155)和停药率(32%对22%,P=0.420)在不同时代之间无显著差异。

结论

IO疗法的应用提高了IMDC有利风险组患者的肿瘤缓解率,尽管需要延长随访以确定是否有生存获益。

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